ADVOCATING TO END ELDER ABUSE OF OUR SENIORS AROUND THE WORLD. IT IS COMMONLY COMMITTED BY A TRUSTED RELATIVE WHO DECIDES THEY WANT THE ELDERS ESTATE FOR THEMSELVES,AND THEY USE UNDUE INFLUENCE TO GAIN CONTROL OVER THE SENIOR'S ESTATE BY TACTICS SUCH AS NEGLECT,ISOLATION,FEAR,OVER MEDICATING,UNDER MEDICATING,PHYSICAL AND VERBAL ABUSE,ETC. IT'S WRONG THAT THE COURTS DON'T FOLLOW THE PROBATE LAWS,WHICH ALLOW THIS CRIME TO PERSIST.

Elder Abuse Advocate News

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Committee on Elder Abuse and Neglect News

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Monday, December 10, 2007

DEFINITION AND TYPES OF ELDER ABUSE

What is the definition of elder abuse? Elder abuse is the intentional or unintentional hurting, whether it be physically, emotionally, sexually, or financially, of a person who is age sixty or older.

What are the types of elder abuse?

Elder abuse usually occurs in one of two locations: domestic elder abuse (in the elder's home); institutional elder abuse (in a nursing home or other long-term-care facility)

The types of elder abuse are:

Physical abuse of the elderly.

Emotional abuse of the elderly (psychological or verbal).

Neglect or abandonment of elders by caregivers.

Self-neglect by elders.

Sexual abuse of the elderly.

Financial exploitation of seniors (elder financial abuse).

Healthcare fraud or healthcare abuse of the elderly.

What is nursing home elder abuse?

Most elder abuse occurs at home.

However, a significant proportion of elder abuse occurs in long-term-care facilities, such as in nursing homes, out of sight of the general public. Nursing home abuse can take any form: physical abuse; emotional abuse; sexual abuse; neglect; financial exploitation; or healthcare abuse. Elder abuse in nursing homes has recently gained media attention, and a federal program has been established to help prevent and resolve such abuse of the elderly. Choosing a reputable nursing home is as important as continually keeping watch over the quality of care in the chosen facility. Look carefully at the contract for the residential care facility. The National Long-Term-Care Ombudsman Resource Center provides advocates to help choose a safe nursing home, as well as to resolve suspected senior abuse in a long-term-care facility.

What is physical abuse of the elderly?

Physical abuse is physical force that results in injury, impairment, physical pain, or the threat of such physical force. Physical violence against an elder in the home is a form of domestic violence. The injury from physical abuse may be from physical punishment of any kind, such as: assault (for example, during a mugging); beating, whipping, hitting (with or without an object); paddling, slapping, or punching; pushing; shoving; shaking; choking; throwing; kicking; pinching;, biting; scratching; spitting; force-feeding; hair-pulling; burning; inappropriate use of drugs and physical restraints; rough handling during caregiving or when moving the body; administration of medicines. The practice of physically restraining elders in a nursing home is particularly troublesome and controversial. Physical restraint may sometimes seem necessary if the elder wants to get up and move around, but is unable to walk without falling. Where staffing is low, the elder cannot be left alone, so the staff uses physical restraints to keep the person in bed or in a chair. If the senior resists the physical restraints, the staff medicates them so that they are more compliant with the restraints. Physical restraint is legal, but many family members would prefer that their loved one fall occasionally, rather than be strapped into a chair or bed against their will.

What is emotional abuse of an elder?

Emotional elder abuse is a verbal or nonverbal act that inflicts emotional pain, anguish, or distress on the elder. It is sometimes also known as verbal abuse, mental abuse, or psychological abuse.Emotional elderly abuse is almost always accompanied by another form of abuse, such as physical abuse.Emotional abuse of the elderly can range from a simple verbal insult to an extreme form of verbal punishment. The following are examples of emotional abuse: ignoring the elder; isolating an elderly person from family, friends, or regular activities; habitual scapegoating or blaming; harassment; name-calling; cursing;, humiliating; insulting or ridiculing; threatening to punish or deprive; intimidating; treating an elder like an infant; using extreme or bizarre forms of punishment, such as confinement to a closet or dark room; tying to a chair for long periods of time; or terrorizing, yelling, or screamingSome overlap exists between the definitions of emotional abuse and emotional neglect. Regardless, they are both elder abuse.

What is elder neglect?

Neglect of the elderly can be either physical or emotional.

Neglect consists of confinement, isolation, or denial of essential services. The caregiver who neglects the elder refuses or fails to provide or pay for the necessities of life, such as food, water, shelter, clothing, healthcare, medicine, comfort, and safety.

Abandonment, a type of neglect, is when the responsible caregiver deserts the vulnerable senior.

Physical neglect of the elderly.A caregiver who physically neglects an elder does not provide for basic physical needs. This kind of neglect includes: lack of supervision and monitoring; inappropriate housing or shelter; inadequate provision of food or water; lack of assistance with eating or drinking; inappropriate clothing for the weather; abandonment; denial or delay of medical care; inadequate help with hygiene or bathing; inadequate hand-washing on the part of the caregiver, which leads to infections; physical restraint (in bed or in another area of the house); incorrect body positioning, which can lead to limb and skin damage; lack of help in moving around, either within the bed or within the physical environment; lack of access to the toilet, or inadequate changing of diapers or disposable briefs, which can lead to incontinence, agitation, and falling when trying to get to the bathroom independently, skin damage from sitting in urine and feces, and indignity.

Emotional neglect (psychological neglect) of the elderly.

Emotional neglect is a lack of basic emotional support, respect, and love, such as: not attending to the elder; ignoring moans, calls for help, or hospital call bells; inattention to the elder's need for affection; failure to provide necessary psychological care to the senior, such as therapy or medications for depression; isolation of the elder from the outer world, including restriction of phone calls, mail, visitors, and outings; lack of assistance in doing interesting activities, such as watching preferred television programs or going out for cultural or intellectual activities.Some overlap exists between the definitions of emotional abuse and emotional neglect, regardless, they are both elder abuse.

What is elder self-neglect?

Elders can neglect themselves by not caring about their own health or safety. Elder self-neglect can lead to illness or injury. The senior may deny themselves or ignore the need for: food or water; bathing or other personal hygiene; proper clothing for the weather; shelter; adequate safety, or clean surroundings; essential medications or medical attention for serious illness.In addition, self-neglectful elders may have the following behaviors: hoarding; leaving a stove on, but unattended; confusion.Note that some elders who are of sound of mind, and not dependent on a caregiver may choose to deny themselves some health or safety benefits. This is not self-neglect, but, rather, personal choice. Others must therefore be sensitive about intervention.

What is sexual abuse of the elderly?

Elder sexual abuse is sexual contact with an elder without that person's consent.This includes: coerced nudity; fondling, touching, or kissing, particularly the genitals; making the elderly person fondle someone else's genitals; forcing the elder to observe sexual acts; photographing the elder in sexually explicit ways; sexual assault of any type (coercion to perform sexual acts), including rape or sodomy; showing the elder pornographic material; spying on the elder in the bathroom or bedroom; telling "dirty" stories.

What is financial exploitation of the elderly?

Financial or material exploitation of an elder is when someone illegally or improperly uses an elder's assets, funds, or property.Because elderly people are sometimes unable to hear or see well or to be as forceful physically or verbally as they used to be, they are easy targets for exploitation.The financial abuser may take, misuse, or conceal the elder's belongings or money.The financial abuser can be a family member; a caregiver or caretaker; a professional, such as an accountant, lawyer, doctor, or banker; a new boyfriend, girlfriend, spouse; or partner; or a stranger.A caregiver who financially exploits an elder takes control of the elder's world.The caregiver might isolate the senior from the outside world, handle all financial matters, withhold food and medicine to weaken the elder, and psychologically abuse the elder so that he or she is afraid of doing anything about the situation.Such a caregiver tells elders that no one else cares about them; that if they don't do what the caregiver says, they will lose their house and have to go into a nursing home; and that they must listen to the caregiver or be punished with physical harm or neglect. If isolated and weakened enough, the elder cannot tell the difference between a caring person who is trying to put financial matters in order and a scheming person who is taking advantage of them.Some of the types of financial elder abuse are: cashing an elder's checks without authorization; using the elder's charge card number for one's own benefit.

Handling an elder's moneywithout a Durable Power of Attorney (the only way which authorizes a person to manage the elder's finances); withdrawing cash from an elder's bank account with an ATM card; transferring money from an elder's bank account without the elder's permission, or forcing/intimidating (UNDUE INFLUENCE) the elder, to gain access to the elder's bank account; scamming an elder by convincing him or her to withdraw money from the bank, and then taking the money; stealing elders' checks, such as Social Security checks or pension checks from the U.S. mail; identity theft, including collecting checks and cashing them after the person has died. Convincing or forcing an elder to sign a contract that results in unwanted financial or material commitments. Convincing or forcing an elder to alter a will to benefit someone that a clear-thinking elder would not have chosen.Enrolling a senior in unneeded services or subscriptions.Getting donations from an elder under false pretenses, defrauding an elder so that they sign up for a particular investment opportunity that isn't really appropriate (investment fraud).Giving the elder incorrect change for a purchase in a store, stealing household goods or money while caring for an elder.Telemarketing fraud by selling sweepstakes entries, where the elder is extremely unlikely to win anything.Forging the senior's signature in a long-term-care facility; not depositing resident funds in separate interest-bearing accounts, embezzling, marrying someone for his or her money, either for a current lifestyle change or to inherit their money after death.

What is healthcare fraud or healthcare abuse of the elderly?

Healthcare fraud or abuse is less visible than some other forms of elder abuse. Healthcare abuse includes: not providing healthcare, but charging for it; overcharging or double-billing for medical care or services; getting kick-backs for referrals to other providers or for prescribing certain drugs; patient abuse or neglect in a hospital, at home, or in a residential care setting; overmedicating or undermedicating; recommending fraudulent remedies for illnesses or other medical conditions.Medicaid and Medicare fraud: includes any of the above types of healthcare fraud or abuse, but specifically carried out in a Medicaid or Medicare facility or funded by Medicaid or Medicare.

Those who carry out healthcare abuse can be: doctors; nurses; hospitals; caregivers; unlicensed medical "professionals" and "nonprofessional" healthcare providers.Some overlap exists between the definitions of caregiver neglect and healthcare abuse.

What are the signs and symptoms of elder abuse?

The following are warning signs of some kind of elder abuse:frequent arguments or tension between the caregiver and the elderly person;changes in personality or behavior in the elder.

If you suspect elderly abuse, but aren't sure, look for clusters of the following physical and behavioral signs.

Some signs and symptoms of physical abuse of the elderly: symmetric injuries on two sides of the body; unexplained bruises; pressure marks; black eyes, welts; lacerations; cuts; burns; bone fractures; broken bones; sprains; dislocations; internal injuries; bleeding; bite marks; broken eyeglasses or frames; signs of being restrained such as rope marks; laboratory findings of medication overdose; under-utilization of prescribed drugs; a sudden change in behavior; caregiver's refusal to allow visitors to see the elder alone; an elder's report of being physically abused.Some signs and symptoms of emotional abuse of the elderly: being upset or agitated apathy; withdrawal; depression; non-communication; sucking; biting; rocking; (behaviors usually attributed to dementia).

Caregiver behaviors such as: belittling; threats; other powerful or controlling behavior; an elder's report of being verbally or emotionally mistreated. Some signs and symptoms of elder neglect: dehydration; malnutrition; extreme hunger; untreated health or medical problems, such as bed sores; hazardous or unsafe living conditions (e.g., improper wiring, no heat, or no running water); unsanitary and unclean living conditions (such as dirt, fleas, scabies, body lice, soiled bedding, fecal or urine smell); unsuitable clothing for the weather; being dirty or unbathed; unusual weight loss; desertion of the elder at a hospital or nursing facility, or other similar institution; desertion of an elder at a shopping center or other public location; physical restraints; chemical restraints (drugs used for behavior control); contractures (muscles that are too stiff to move easily); an elder's report of being mistreated or abandoned.

Some signs and symptoms of sexual abuse of the elderly: bruises around the breasts or genitals; unexplained venereal disease or genital infections; unexplained vaginal or anal bleeding; torn, stained, or bloody underclothing; an elder's report of being sexually assaulted.

Some signs and symptoms of financial or material exploitation of the eldery are: large cash withdrawals from the elder's bank account; the elder's withdrawal of a large sum of money from the bank when accompanied by another person; numerous withdrawals from the elder's bank account, particularly in round amounts, such as $100 or $1,000, $10,000, etc; large checks written to unusual or unknown recipients; names being added to the senior's bank account signature card; objects or money missing from the senior's household;, withdrawals from investments, in spite of penalties for early withdrawal; abrupt changes (such as beneficiaries) in wills, trusts, contracts, Power of Attorney, Durable Power of Attorney, property titles, deeds or mortgages, changes in beneficiaries on insurance policies or IRA's; sudden changes in the elder's financial situation; home or institutional care that is lacking, despite sufficient funds to cover the care; unpaid bills, despite enough assets to cover the payments; forged signatures; unnecessary services, goods, or subscriptions.

Financial activity that is inconsistent with the elder's abilities or usual activity, such as ATM withdrawals, (such as when the elder never leaves the house, or elder is in hospital or nursing home); the sudden appearance of friends or relatives claiming the right to goods or inheritance; sudden close relationship with a much younger, more able person (including marriage or domestic partnership); an extreme interest in and participation, or control of the elder's financial matters on the part of the caregiver; the caregiver has no other means of support besides caring for the elder; the caregiver has drug or alcohol problems; the caregiver has a gambling problem; the caregiver has mental health problems; the elder's sudden reluctance to discuss financial matters; increasing tiredness or depression on the part of the elder; increasing lack of contact with and interest in the outside world; reluctance to accept visits or phone calls; the caregiver restricts the elder's contact with the outside world, such as speaking for the elder, refusing phone calls, preventing visits, reading mail for the elder, handling all expenditures, and not taking the elder on purchasing errands or other outings, or leaving them in the car; the elder's admission or expressed fear of their well-being and financial or material exploitation, or suspected exploitation.

Some signs and symptoms of healthcare abuse or fraud of the elderly: duplicate billings for a medical service or device; the count of pills left in a container is either under or over the expected amount for the period of time for which they were prescribed; lack of or inadequate medical care, even though bills are being paid in the elder's living space; a huge number of remedies for various medical conditions, including many non-prescription remedies.

What are the causes of elder abuse?

Sometimes, those who care for elders are not suited to the requirements of the job (drugs, alcohol, gambling, mental health, etc.), and they allow themselves to vent their impatience, frustration, and anger on the elder whom they are supposed to be protecting and nurturing.

In nursing homes, in particular, staff may be prone to elder abuse because of: insufficient staffing; lack of training; stressful working conditions; staff burnout.Sometimes neglect is not intentional, it may be the result of lack of adequate training about how to care for the elderly or because staff members cannot monitor needy elders in a timely manner.

Taking care of the elderly, whether at home or in an institution, can be very stressful. The incidence of depression is very high among caregivers.

Many people with dementia have trouble sleeping, so caregivers are kept up caring for them.

Caregivers have a high level of anxiety, because stress affects the heart and cardiovascular system, the stresses of caregiving can even lead to death in the caregiver. The amount of stress that the caregiver experiences depends upon: the elder's type of disease or dementia.

The progression of the elder's requirements for care; at first, care may have been mundane errands or financial management, but the needs may have progressed to helping to eat, bathe, and toilet. How the caregiver perceives the responsibility of caring for the elder (burdensome or not), what the elder thinks about the caregiver, how the caregiver perceives the care recipient, if the caregiver finds the care recipient to be ungrateful, the caregiver is more likely to feel stressed. How close the elder and caregiver were before and how close they are now. How the caregiver copes with stress, in general (resilience), whether others help with the caregiving. Violence or aggression from the elder. Caregiver depression, and living with the care recipient are predictors of caregiver elder abuse. Violence from a care recipient toward the caregiver is strongly related to subsequent caregiver violence. A history of domestic violence in the household makes a senior more likely to be included in the domestic violence.

Financial exploitation of the elderly is related to the lack of boundaries regarding using another person's belongings and money.Sometimes this lack of boundaries is criminal, and sometimes it is simply a lack of ethical behavior. The exploiter gains because of the vulnerability of the elder.

Who abuses the elderly?

Most elder abuse occurs in the elder's home, and the abuser is usually a family member.Most commonly, the perpetrators of elderly abuse are spouses/partners, of elders.

Next most frequent abusers are the adult children of elders, and sibblings of elders.

Abusers can be men or women. Men ages thirty-six to fifty are the most common perpetrators. In nursing homes and other long-term-care facilities, the abusers may be employees, outside visitors, or intruders.

Either hotline has people who can talk to you and provide referrals for you, to help prevent your abusing an elder.

Over the long term, find ways to relieve the stresses of being totally responsible for the care of an elderly person.

Ask others to help care for the elder so that you can take breaks. Seek out local respite care agencies (for short breaks).

Find an adult day care program to give you time off during the day.

If you typically resolve frustration or anxiety with abuse, neglect, or violence, learn other ways to cope.

The first step in changing is to talk with a friend, family member, counselor, therapist, pastor, priest, or rabbi.

If you are using alcohol or drugs to mask your frustration, contact Alcoholics Anonymous or another self-help or support group.

How can elder abuse be prevented?

Elders themselves are unlikely to be on the forefront of prevention of elder abuse.

Elders are most often silent in their suffering because they may be physically unable to speak out and because society does not listen well.

One of the ironies of elder abuse is that younger people may be too busy to listen or act.

Elders in westernized societies are often pushed away from the hub of action and ignored.

Prevention is especially important because the majority of elder abuse cases go unreported.

We cannot even count how many elderly abuse cases we prevent by making changes that stop abuse.

Through prevention, we can make elders' last years more pleasant, and we can save elders' lives.

Key elements in the prevention of elder abuse are:

Educate.

Enforce

Intervene.

The public can help to prevent elder abuse by helping to educate seniors, professionals, caregivers, and others about elder abuse.

If you cannot directly help, you can volunteer or donate money to the cause of educating people about elder abuse.

Encourage law enforcement agencies to prosecute elder abuse when they find it.

Mental health professionals, social workers, nurses, and lawyers can step up interventions.

Caretakers can prevent abusing their elderly charges by doing the following:

Stay healthy and get medical care for yourself when necessary.

Get professional help for drug or alcohol abuse, which can lead to elder abuse.

Seek counseling for depression, which can lead to elder abuse.

Make contact with domestic violence prevention services.

Find a support group for spouses, partners, or grown children caring for the elderly.

Family members and friends who are not caregivers of the elder can help to prevent abuse.

Watch for warning signs that might indicate elder abuse.

Make sure that the elderly person is eating properly and taking required medications. A weakened elder cannot think clearly about the care being given.

Scan bank accounts and credit card statements for unauthorized transactions, if you can get access permission from the elder.

Watch for possible financial exploitation.

Call and visit as frequently as you are able.

Keep the lines of communication open so that the elder feels comfortable talking about abusive behaviors.

Gain trust so that the elder allows you more oversight in financial and caretaking matters.

An elder can do the following to prevent elder abuse:

Plan for your own financial future with a trusted person or persons.

Make sure that your finances are in order: beneficiaries of insurance policies and IRAs; durable power of attorney; your will; a living will for healthcare instructions; any trusts you wish to create; titles to your assets, and so on.

Be socially active and avoid social isolation, which can make you vulnerable to elder abuse.

Keep in touch with family and friends. If you are not happy with the care you are receiving from your family or from another caregiver in your home, speak up. You have a right to your preferences. If you live in a long-term-care facility and have no one close to you who can speak up for you when you are not happy about your care, contact your state's Long-Term-Care Ombudsman. The Ombudsman's charter is to be your advocate and to intervene when necessary. References and resources about elder abuse. Important phone hotlines. National Domestic Violence Hotline is a crisis intervention and referral phone line for domestic violence. The service also has an email address and access for the deaf. Hotline staff members can speak in English or Spanish and have access to translators for many other languages. State Elder Abuse Hotlines is a list of phone numbers for reporting elder abuse in the fifty United States. Each state has one number for reporting domestic elder abuse and another for reporting institutional abuse. Because each state is ultimately responsible for investigating elder abuse cases through Adult Protective Services, you need to contact your state's authorities. Always call 911 first if the elder abuse is an emergency situation. National Long Term Care Ombudsman Resource Center gives phone numbers for long-term-care ombudsmen, by state within the United States. The federal government requires that each state have a long-term-care ombudsman to help people to find satisfactory long-term care and to help resolve problems with long-term-care facilities. Eldercare Locator: Community Assistance for Seniors, from the Department of Health and Human Services, and the Administration on Aging, provides a toll-free hotline for locating safe, reputable services and housing for seniors: 1-800-677-1116. The website also can help you to locate services for your geographical area. Use the handy wizard to locate what you need. If you are dealing with elder abuse, for the question entitled Aging Information Source, specify Elder Abuse Prevention to get information on elder-abuse resources in your area. General Missing Voices: Views of older persons on elder abuse, from the World Health Organization (WHO), the International Network for the Prevention of Elder Abuse (INPEA), and other partners, is a very thought-provoking, sophisticated, and sensitive article that challenges the existing categorizations of elder abuse.

By interviewing elders and primary healthcare workers in five developing countries, the researchers identified the following additional categories of elder abuse that have not been discussed much in the western-focused literature on elder abuse.

Structural and societal abuse (being pushed to the edges of society).

Disrespect and ageist attitudes.

This is the first international, cross-cultural research study to be published on elder abuse. It teaches us to consider the cultural context of elder abuse, as well as to value the viewpoints of the elders themselves in helping us to prevent abuse. The ultimate goal of the study was to develop a global strategy for preventing elder abuse. The researchers place the burden of prevention on society, they do not consider elder abuse to be solely a family issue. A quote from the article sums up the message.

"The challenge for all of us is not only to listen to what has been said, but to believe and act upon it."

Elder Abuse and Neglect, In Search of Solutions, from the American PsychologicalAssociation Online is a general article that covers the basics about elder abuse, identifying elder abuse, reporting elder abuse, and prevention of elder abuse.

Promising Practices, from the National Center on Elder Abuse (NCEA), is a database of help for specific kinds of elder abuse, neglect, and exploitation.

You enter the category of elder abuse, the state where the elder lives.

The results show resources available for that kind of abuse in that state.

A Response to the Abuse of Vulnerable Adults.

The 2000 Survey of State Adult Protective Services, from the National Center on Elder Abuse (NCEA), summarizes elder abuse statistics as collected by Adult Protective Services agencies in the fifty states. Help for caregivers A Fact Sheet on Caregiver Stress and Elder Abuse, is an excellent brochure documenting the reasons for caregiver elder abuse, the signs of caregiver stress and elder abuse, how caregivers can avoid abusing an elder, and what other people can do to prevent caregiver abuse.

Preventing Elder Abuse by Family Caregivers, from the National Center on Elder Abuse (NCEA), is an article reviewing the scientific literature on family caregiver abuse. The article looks at caregiver stress and at the predictors of caregiver abuse.

Among many other non-intuitive findings is the assertion that caregiver depression and living together with the care recipient are predictors of abuse. A good portion of the article lists resources for preventing abuse.

Preventing Stress from Becoming Harmful. A Guide for Caregivers speaks directly to caregivers who are about to abuse or who are abusing elders. This brochure, from the Institute on Aging for the National Center on Elder Abuse, offers practical, concrete suggestions on what the caregiver can do to avoid becoming abusive. Ensuring elders' safety and comfort in their own homes.

Aging Parents and Adult Children Together (A/PACT),Making the Home Senior-Friendly, from the Federal Trade Commission in partnership with AARP, discusses ways to make the senior's home safe and comfortable, to prevent injury and stress. A home that is designed for senior living can prevent unintentional caregiver neglect or elder self-neglect.

Elder abuse in nursing homes, Housing Choices. If Nursing Home Problems Occur is the American Association of Retired Persons' (AARP), coverage of the topic of how to deal with lack of care or abuse of an elder in a nursing home.

Financial exploitation of the elderly.

Elder Financial Abuse, is a concise summary of the definition of financial abuse, warning signs, who might exploit an elder, what to do to prevent elder financial abuse, how to choose an elder's caregiver, and more. Although the brochure was produced for residents of San Bernardino County in California, the information is useful for everyone.

Aging Parents and Adult Children Together (A/PACT): Consumer Fraud Against the Elderly, from the Federal Trade Commission in partnership with AARP, discusses telemarketing and consumer fraud, particularly as they apply to the elderly. The words "free" and "act now" are particularly common in consumer fraud. The article includes recommendations for how to prevent telemarketing fraud.

Aging Parents and Adult Children Together (A/PACT): Daily Money Management Programs, from the Federal Trade Commission in partnership with AARP, describes a simple way of helping an elder with daily money management: hiring a daily money manager. If a loved one does not have the ability or time to help an elder with such financial matters as paying bills, balancing the checkbook, and reconciling health insurance claims, hiring a money manager is the first stage of helping the elder to manage their finances. You can hire a daily money manager to come in as a convenience, and thus prevent a later financial emergency that could occur if the daily matters were not under control.

Aging Parents and Adult Children Together (A/PACT): Alternatives to Guardianship, from the Federal Trade Commission in partnership with AARP, is a broad article describing various legal ways to help an elder with financial matters. The article discusses the legal definitions of financial guardian, financial conservator, power of attorney, durable power of attorney, representative payee for Social Security payments, and living trust. If the elder is having trouble managing finances, he or she may need to appoint someone as an agent. A power of attorney or durable power of attorney is the most flexible, mild way of appointing someone to help the elder with finances. If the elder is totally incapacitated, someone may need to push for a financial guardian or conservator.

Healthcare fraud and abuse.

Most Common Medicaid "Rip Offs" lists examples of Medicaid fraud and abuse, with instructions on how to report such rip-offs.

Tips to Prevent Fraud, from the Centers for Medicare and Medicaid Services, provides tips for watching out for Medicaid abuse, plus instructions on how to report Medicaid fraud or abuse.

Self-protection for elders IMPACT Safety Programs is a self-defense training program for people, including seniors, that focuses on quick response and retreat from danger. Impact teaches verbal response to stop aggression, as well as physical self-protection to stop an attacker so you can get away and call for help.

Impactis called Model Mugging in some parts of the country. A key element of the classes is padded instructors who "attack" the participants so they can practice their newly learned self-defense skills. Classes for seniors are tailored to the abilities of people who may not be strong or mobile.

F.A.S.T. Defense lists locations around the world where you can take FAST self-defense classes. Many of the locations offer self-protection classes for seniors. FAST stands for Fear-Adrenal-Stress Training. FAST self-defense teaches how to respond verbally to a threat, as well as how to respond physically when required. Part of the effectiveness of this training is the use of padded instructors that class participants fight against. No one is hurt, and classes for seniors are customized to suit the abilities of the participants.

The Raising Canes Club, a part of the FAST location in British Columbia, teaches the novel technique of using your cane for self-defense, to fight off a physical attack on the street or in your home. You can either attend their classes or purchase a video online that summarizes what the class teaches.+++++++++++++